Revenue Integrity Specialist

3 weeks ago

San Diego CA United States Planned Parenthood of the Pacific Southwest Full time
As a Revenue Integrity Specialist you will have the opportunity to partner and assist the Financial Planning & Analysis Supervisor, work alongside key finance and revenue cycle management and other internal/external stakeholders to develop detailed analysis, key performance indicators, and reporting to drive better business performance.

This critical position will ensure accurate payments from third party payers in compliance with Managed Care contracts and government fee schedules. Additionally, you will work internally across functions to analyze current workflows and processes to define ways to measure performance improvement, drive increased cash flow and revenue, achieve reporting efficiencies, and leverage cost savings.

The ideal candidate will be adaptable, flexible, detail oriented and a great communicator. If you are highly self-motivated, driven by our mission, and able to build strong, collaborative relationships across all levels of the organization, apply now
In this role, you’ll get to:
Routinely review and audit clinic billing & collections to ensure timely billing and maximize collections according to insurance contracts and established fee schedules, and proactively identify risks and problems impacting agency cash flow.

Provide thorough data analysis of all A/R behavior, with particular attention to billing, collections/follow/up, denials management, credit balance reconciliation to identify payer trends & patterns.

Identifies revenue cycle problems and recommend solutions for improvement.

Work closely with revenue cycle management, health center operations, IT and other departments, ensuring that applications/technologies/workflows function.

Provide weekly, monthly, and quarterly reporting packages, trend analysis, and KPI reports.

Assist with recovery efforts for both over payments and under payments against contract.

Work closely with revenue cycle leadership to develop metrics to reduce controllable denials, write-offs and increase revenue intake.

Perform calculations and prepare general ledger journal entries for patient services revenues, accounts receivable, patient visits and productive hours, and other financial and/or statistical accounts as assigned.

Assist and prepare complex financial and statistical reports that summarize and forecast agency business activity and financial position utilizing financial reporting software.

Perform special analytical projects and ad hoc analyses by doing research, creating models and make recommendations based on results. Prepare pro-formas for strategic business plan initiatives and operational objectives.

Assist with the development of agency budgets by setting up budgeting software, establishing schedules, collecting, analyzing, and consolidating financial data and recommending plans.

Assist with the monitoring and evaluation of budget-to-actual and year-over-year activity ensuring significant deviations are communicated to appropriate decision makers.

What we’re looking for:
Bachelor’s Degree or Equivalent Experience (4 years total experience in Finance or Accounting) required

3+ years in billing, collections, accounting or finance with emphasis on financial analysis required

Healthcare Industry experience required

Ability to apply thorough knowledge of the financial concepts, theories, principles and practices of business analysis required

Advanced experience in working with large data sets, multiple data sources, and interpreting complex data to create meaningful information required

Experience analyzing payer payments on medical insurance claims required

Ability to apply business acumen to external stakeholders required

A thorough understanding of planning and analysis for a multi-faceted healthcare organization required

Strong written and verbal communication skills required

Preferred Qualifications:
Previous Non-Profit experience preferred

Experience with the following computer applications is a plus: Sage Intacct Enterprise Resource Planning (ERP), Paylocity Human Capital Management (HCM), and NextGen Practice Management, EPIC Practice Management preferred
At Planned Parenthood of the Pacific Southwest (PPPSW) the philosophy behind our compensation efforts is to foster workplace equity by aligning pay and benefit structures with our Agency’s mission and values. These efforts are continuously evaluated as we work toward living out our social justice values as an employer. PPPSW recognizes that decisions about pay and benefits have significant impact on staff, and we work diligently to ensure all positions are compensated competitively as compared to other similar positions in the community. The Affiliate establishes compensation supported by a position description that identifies competencies, duties, responsibilities and qualifications. In alignment with the Agency culture, PPPSW will strive to communicate openly and transparently about the goals of the Agency and the design of the compensation policies. The Agency will ensure the compensation program is administered in a manner that is consistent with Agency’s value of pay equity.

PTO, 401K Matching Program, Educational Assistance, Access to 1:1 Mental Fitness/Life coach, Premium CALM account and more

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